Complications and discomfort of bronchoscopy: a systematic review

Figures & data

Table 1 Search word combinations, in a modified PICO form for a systematic literature search on complications and discomfort related to bronchoscopy

We are interested in a procedure called (Intervention 1)	Where … is performed. (Intervention 2)	Will it lead to …? (Outcome)
Bronchoscopy	Bronchoalveolar lavage	Complication^a
	BAL	Discomfort
	Brush^a	Cough^a
	Transbronchial biopsy	Saturation decrease
	Endobronchial biopsy	Adverse events
	Bronchial biopsy	Adverse effects
	Conscious sedation	Bronchospasm
	Lidocaine	Death
		Pneumothorax
		Shortness of breath
		Dyspnoea
		Bleeding
		Haemorrhage
		Fever
		Vasovagal syncope
		Cardiac arrest
		Contraindication
		Safety
		Patient experience
		Adverse symptoms
		Anxiety
		Pain
		Hospitalisation

^aTruncation. The content of columns was combined with OR. Different columns were combined with AND.

Table 2 Yield of a PubMed – literature search on discomfort and complications related to bronchoscopy (8 February 2016)

	Number of articles
Total in search	1,707
Type of publications
Excluded, non-original	214
Excluded, language	183
Excluded, case studies	268
Excluded, not human	37
Type of bronchoscopy
Excluded, provocation test	24
Excluded, interventional bronchoscopy	26
Excluded, general anaesthesia/intubated/ mechanical ventilation/ICU	149
Excluded, endobronchial ultrasound (EBUS)	32
Excluded, experimental or non-standard  bronchoscopy techniques	7
General
Excluded, no relevance/does not address  complications nor patient experience	381
Excluded, children	110
Excluded, disease outbreak study	3
Excluded, did not report according to  objective^a	1
Publications excluded, total	1,435
Publications remaining, total	272

^aOne study did not report complications, despite the objective ‘(…) to document any complications’.

Table 3 Quantitative overview of articles from a systematic literature search on complications and discomfort of bronchoscopy, divided into groups based on study design characteristics, number of subjects investigated, and relevance to the topic of complications and discomfort

	Subjects	Primary objective	Secondary objective	Reports complication	Claims ‘no complications’	Total
Prospective studies	n>200	14^a	3^a	4	0	21
	n 50–200	31^a	2^a	26	4	63
	n<50	28	4	31	11	74
Retrospective studies	n>200	15^a	4^a	12	3	34
	n 50–200	3^a	2^a	13	2	20
	n<50	8	7	7	7	29
Medication studies	n>200	5^a	0	0	0	5
	n 50–200	15^a	0	0	0	15
	n<50	8	0	3	0	11
Total		127	22	96	27	272

^aIn total, 94 articles reported complications and discomfort as their primary or secondary objective in procedures on more than 50 subjects.